The association between the work environment and the fear of Covid-19 experienced by nurses.

BACKGROUND: The conditions in the workplace have a critical influence on the mental health of nurses and their attitudes toward their job, which may impact patient care. OBJECTIVE: This cross-sectional study aimed to investigate the association between perceptions of the work environment and fear of COVID-19 experienced by nurses. METHODS: The data were collected using a demographic data form, the Work Environment Scale (WES), and the Fear of COVID-19 Scale. The study was completed with 183 nurses who provide care to COVID-19 patients. RESULTS: The mean scores for the WES and Fear of COVID-19 Scale were 63.59±12.35 and 21.98±8.36, respectively. There was a positive correlation between the points acquired from the "employee fears" section of the WES and the Fear of COVID-19 Scale mean ranks (r = 0.22). There was a weak negative correlation between the Fear of COVID-19 score and the WES "job satisfaction" score (r = -0.214). There was a weak negative correlation between the scores of the Fear of COVID-19 Scale and perceived support at work (r = -0.33) and between the WES scores and weekly working hours (r = -0.27). However, there was a weak to moderate positive correlation between the WES scores and number of days off per week (r = 0.45). CONCLUSIONS: Nurses experience a high fear of COVID-19, and a decrease in their attitudes of the work environment was associated with an increased fear of COVID-19. The fear of COVID-19 may be reduced by various interventions to provide support at work and increase nurses' job satisfaction.

Core requirements of frailty screening in the emergency department: an international Delphi consensus study.

INTRODUCTION: Frailty is associated with adverse outcomes among patients attending emergency departments (EDs). While multiple frailty screens are available, little is known about which variables are important to incorporate and how best to facilitate accurate, yet prompt ED screening. To understand the core requirements of frailty screening in ED, we conducted an international, modified, electronic two-round Delphi consensus study. METHODS: A two-round electronic Delphi involving 37 participants from 10 countries was undertaken. Statements were generated from a prior systematic review examining frailty screening instruments in ED (logistic, psychometric and clinimetric properties). Reflexive thematic analysis generated a list of 56 statements for Round 1 (August-September 2021). Four main themes identified were: (i) principles of frailty screening, (ii) practicalities and logistics, (iii) frailty domains and (iv) frailty risk factors. RESULTS: In Round 1, 13/56 statements (23%) were accepted. Following feedback, 22 new statements were created and 35 were re-circulated in Round 2 (October 2021). Of these, 19 (54%) were finally accepted. It was agreed that ideal frailty screens should be short (<5 min), multidimensional and well-calibrated across the spectrum of frailty, reflecting baseline status 2-4 weeks before presentation. Screening should ideally be routine, prompt (<4 h after arrival) and completed at first contact in ED. Functional ability, mobility, cognition, medication use and social factors were identified as the most important variables to include. CONCLUSIONS: Although a clear consensus was reached on important requirements of frailty screening in ED, and variables to include in an ideal screen, more research is required to operationalise screening in clinical practice.

Use and uptake of technology by people with dementia and their supporters during the COVID-19 pandemic.

OBJECTIVE: This rapid review aims to identify the types of technologies used by people with dementia and their supporters during the COVID-19 pandemic, and the issues which influenced technology adoption within their usual care routines. METHODS: PubMed, PsychInfo, Scopus, and Cochrane COVID reviews were searched to identify peer-review studies published since 2020. A total of 18 studies were included and synthesised thematically. RESULTS: Of these, most were conducted in the community (n = 15) with people with dementia only (n = 11) and involved qualitative methods (n = 11). The majority (n = 12) focused on digital off-the-shelf and low-cost solutions, such as free video conferencing platforms, to access care, socialise or take part in interventions. Whilst often well-accepted and associated with positive outcomes (such as improved social connectedness), lack of digital literacy or support to use technologies, limited access to appropriate technology, individuals' physical, cognitive, or sensory difficulties, were highlighted and likely to threaten the adoption of these solutions. The quality of the evidence was mixed, neither very robust nor easily generalisable which may be attributed to the challenges of conducting research during the pandemic or the need to rapidly adapt to a new reality. CONCLUSION: While COVID-19 has fast-tracked the adoption of technology, its use is likely to continue beyond the pandemic. We need to ensure this technology can leverage dementia support and care and that people with dementia are enabled and empowered to use it.

Frailty Knowledge, Use of Screening Tools, and Educational Challenges in Emergency Departments in Ireland: A Multisite Survey.

BACKGROUND: Recognizing frailty and providing evidenced-based management in busy emergency departments is challenging. Understanding the knowledge and educational needs of ED staff is important to design training that might improve patient outcomes. OBJECTIVE: This study aimed to explore frailty knowledge of ED staff, use of frailty screening instruments in Irish emergency departments, and educational challenges in the emergency department. METHODS: A multisite survey of ED staff (different specialties) was conducted between April and September 2021. An anonymous online survey was distributed via email. Free-text sections were analyzed using content analysis. RESULTS: In total, 168 staff (nursing, medical and allied health) participated, representing 9 of 26 Irish emergency departments (35%). Most respondents were nurses (n = 78, 46%). Less than half of respondents had received frailty identification training (n = 81, 48%). One-fifth of emergency doctors and nurses (20%) were unsure how to define frailty. Major barriers to ED frailty screening were resource deficits, insufficient diagnostic pathways from the emergency departments, and lack of education on suitable instruments. CONCLUSIONS: Most of the ED staff surveyed relied on clinical judgment rather than formal training in frailty identification. A high proportion reported poor knowledge and low confidence in recognizing frailty. Dedicated staff with frailty management expertise, bespoke education initiatives, and clearly defined frailty screening pathways may help address the issues identified.

The effectiveness of interventions to improve the seasonal influenza vaccination uptake among nurses: A systematic review.

Background: Seasonal influenza is a significant cause of mortality and morbidity worldwide. Despite annual recommendations, influenza vaccination uptake rates are disproportionately lower among nurses compared to other health care professionals, especially when compared to physicians. Nurses have an additional risk of exposure to influenza infection due to the nature of their work. Aim: To determine the effectiveness of interventions in increasing seasonal influenza vaccination uptake among nurses. Methods: Evidence on the effectiveness of interventions to improve seasonal influenza vaccination uptake among nurses was systematically reviewed. A comprehensive search of six electronic databases and grey literature was undertaken. A minimum of two reviewers completed study selection, data extraction and risk of bias assessment independently. Results: One hundred and thirty-four studies were identified of which one cluster randomised trial met the inclusion criteria. The results of the included study found the implementation of an intervention with multiple components increased nurses' seasonal influenza vaccination rates during a single influenza season in geriatric healthcare settings in France. As the evidence in this review was very limited, it was not possible to make recommendations regarding which interventions were effective at increasing the seasonal influenza vaccination rate for nurses. Conclusion: This systematic review highlights a lack of high-quality studies that assessed interventions to improve the seasonal influenza vaccination of nurses. In view of the likelihood of influenza and the coronavirus (COVID-19) pandemic occurring together, it is imperative to have evidence on effective interventions for the nursing workforce and for policy decision makers.

Comparing frailty prevalence between countries: validation of the Global Burden of Disease study Frailty Index (GBD-FI) in the survey of health, ageing and retirement in Europe.

BACKGROUND: Accurate comparable prevalence proportions are required to better understand the epidemiology of frailty. Estimates in many countries are missing or incomparable. The Global Burden of Disease Frailty Index (GBD-FI) applies the deficit accumulation model to generate frailty scores from items available in the Global Burden of Disease study. OBJECTIVE: To externally validate the GBD-FI. METHODS: Data were obtained from the Survey of Health Ageing and Retirement in Europe (SHARE). A 20-item modified GBD-FI was compared with established frailty measures: a 70-item frailty index (FI-70), the Clinical Frailty Scale (CFS), Frailty Phenotype (FP) and SHARE-FI. Area under receiver operating characteristic curves (AUC) were fitted to examine diagnostic accuracy for frailty and predictive validity for 2-year mortality. RESULTS: In total, 31,624 participants aged ≥50 years from 15 countries were included. Frailty prevalence was 22% using the GBD-FI (ranging from 8% in Switzerland to 41% in Poland). The GBD-FI had good to excellent diagnostic accuracy for frailty, irrespective of approach; the AUC ranged from 0.86 (95% confidence interval: 0.85-0.87) measuring frailty using the CFS to 0.94 (0.93-0.94) with the FI-70. The GBD-FI had similar accuracy for 2-year mortality (AUC 0.71, 0.69-0.74) compared with the CFS (0.73; P = 0.186), FP (0.73; P = 0.392) and SHARE-FI (0.70; P = 0.255) but lower than the FI-70 (0.76; P < 0.001). CONCLUSION: The GBD-FI demonstrated concurrent and predictive validity, suggesting it is a valid measure of frailty. It has the potential to be an efficient, replicable and consistent approach to comparing frailty between countries and regions across time using GBD data.

Systematic review of topical interventions for the management of pain in chronic wounds.

Chronic wounds adversely affect quality of life. Pain is associated with chronic wounds, and its impact can vary according to wound aetiology, condition, and patient factors. This systematic review examined the effectiveness of topical interventions in the management chronic wound-related pain guided by PRISMA recommendations of randomised controlled trials (RCTs) where pain reduction is the primary outcome. Inclusion criteria were adults (older than 18 years) with chronic venous, arterial, diabetic, or pressure ulcers where pain has been managed through topical administration of pharmacological/nonpharmacological agents. Searches were conducted in Ovid Embase, Ovid MEDLINE, EBSCOhost, CINAHL, CENTRAL, PubMed, Web of Science, and Scopus. Studies were screened for eligibility; risk of bias and data were extracted by 2 independent assessors. Searches retrieved 10,327 titles and abstracts (7760 after deduplication). Nine full texts (1323 participants) examining ibuprofen (n = 4), morphine (n = 2), BWD + PHMB [polihexanide-containing biocellulose wound dressing] (n = 1), and EMLA (n = 2) were included. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool. Meta-analysis was not possible, but initial exploration suggests improved outcomes (reduced pain) for ibuprofen when compared with controls. Two studies involving morphine showed conflicting findings. Included studies often had small samples, and considering confounding factors (eg, comorbidities), the results should be interpreted with caution. Review of included studies suggests that topical interventions may provide pain relief in individuals with chronic wounds. Further adequately powered RCTs are recommended to assess the efficacy of topical interventions for the management of chronic wound-related pain.

Defining palliative wound care: A scoping review by European Association for Palliative Care wound care taskforce.

BACKGROUND: Deciding whether to transition to wound palliation is challenging for health care professionals because there is no agreed definition or understanding of palliative wound care, including the goals, core elements and differences from general wound management. OBJECTIVES: To conduct a scoping review with qualitative synthesis to define palliative wound care in terms of its conceptual framework, goals, principles, components, and differences from general wound management, and provide a new definition of palliative wound care based on this scoping review. ELIGIBILITY CRITERIA: Published literature that refers to the definitions, concept, goals and core elements of palliative wound care using any methodological approach, without any time limits, published in English. SOURCES OF EVIDENCE: The searches were conducted in CINAHL Complete via Ebsco, Medline via Ovid, Cochrane Library, Scopus, and Google Scholar. CHARTING METHODS: A data extraction form was developed by the review team and used independently for data charting purposes. Braun and Clarke's six phases of thematic analysis guided the qualitative synthesis. RESULTS: A total of 133 publications met the inclusion criteria. Three main themes were developed to define palliative wound care and understand its differences from general wound management: 1- Healing potential of wounds and patient vulnerability, 2- Understanding the impact on individuals and family to address needs, 3- Towards new goals and perspectives in approach to care. CONCLUSIONS: Palliative wound care focuses on symptom management, comfort, and dignity, but does not always target the healing of the wound, which is the goal of general wound care. The needs of the individual and their family must be addressed by clinicians through the provision of care and support that takes into account the true meaning of living and dying with a palliative wound. PROTOCOL REGISTRATION: A review protocol was developed but not registered.

Patients 'acceptance' of chronic wound-associated pain - A qualitative descriptive study.

Chronic wound-associated pain negatively impacts the quality of life of individuals and their families. To date, little research exists that has explored collectively how individuals describe wound pain, strategies they use to manage pain, and the perceived effectiveness of such strategies. Therefore, qualitative, semi-structured interviews were carried out between June and August 2021 with 13 individuals to gain a deeper understand of the experience and impact of chronic wound-associated pain in this population. Data were analyzed following Braun and Clarke's approach for reflexive thematic analysis using MAXQdA®. Two themes and subthemes were identified. Theme 1 reflects participants' characterization of pain and how wound-associated pain affected their daily life and how they learned to accept it. Participants felt functionally impaired. In theme 2, participants described how they accepted to live with such a pain even though they received support to manage their chronic wound-associated pain, especially during the dressing-changes. Patients depended on their health care professionals and family support networks to cope with the pain. Coping with pain is exhausting contributing to poorer quality of life. Health care professionals should be aware of wound-associated pain during dressing changes. Patients recommended the need for further research on dressings and not drugs to manage pain.

Diagnostic Accuracy of Frailty Screening Instruments Validated for Use among Older Adults Attending Emergency Departments: A Systematic Review and Meta-Analysis.

Early identification of frailty can prevent functional decline. Although multiple frailty screens exist for use in Emergency Departments (EDs), few are validated against diagnostic standards such as comprehensive geriatric assessment. To examine the diagnostic accuracy of ED screens for frailty, scientific databases were searched for prospective diagnostic accuracy test studies from January 2000 to September 2022. Studies were assessed for risk of bias using QUADAS-C. Psychometric properties were extracted and analysed using R. Six studies involving 1,663 participants describing seven frailty screening instruments (PRISMA-7, CFS, VIP, FRESH, BPQ, TRST, and ISAR), representing 13 unique data points, were included. The mean age of participants ranged from 76 to 86 years. The proportion that was female ranged from 45 to 60%. The pooled prevalence rate of frailty was high at 59%. The pooled estimate for sensitivity was 0.85 (95% CI: 0.76-0.91) versus 0.77 (95% CI: 0.62-0.88) for specificity. Pooled accuracy based on area under the ROC curve was 0.89 (95% CI: 0.86-0.90). Although few studies were found, limiting the ability to conduct a meta-analysis of individual instruments, available frailty screens can accurately diagnose frailty in older adults attending the ED. As specificity was comparatively low, additional assessment may be required to identify those requiring inpatient management or onward community referral. Further study is therefore required.

Topical interventions for the management of pain in chronic wounds: A protocol for a systematic review.

Background: Venous, arterial, diabetic and pressure ulcers, collectively known as chronic wounds, negatively impact individuals across psychological, social and financial domains. Chronic wounds can be painful and the nature, frequency and impact of pain can differ depending on wound aetiology, wound state and on numerous patient factors. While systemic pharmaceutical agents have some effect in managing pain, there is a need to examine topical agents applied to the wound bed for pain relief. The objective of this study is to examine and synthesise existing literature on the effectiveness of topical agents in managing pain in venous, diabetic, pressure, arterial and mixed venous/arterial ulcers. Methods: We will use Cochrane Systematic Review methodology to identify and synthesise eligible randomised controlled trials (RCTs) evaluating the effectiveness of topical agents in reducing pain in chronic wounds. Embase, Medline, PubMed, CENTRAL, CINAHL, Scopus and Web of Science will be searched from inception to end of June 2022 without language limits. We will independently extract data on the pharmaceutical agent, participant demographics, aetiology, condition of the wound, and type, nature and frequency of pain using a pre-designed data extraction form. Subgroup and sensitivity analysis will be performed to address heterogeneity across studies if appropriate. Further stratification and analyses will be based on included study variables and outcomes. Discussion: Wound pain is primarily managed via systemic pharmaceutical agents. However, patients express reluctance regarding systemic analgesic drugs, fearing addiction. Additionally, persons with chronic wounds have co-morbidities including hypertension, diabetes, or cardiovascular disease and are already taking multiple medications. Topical analgesia can potentially mitigate some of the perceived disadvantages of systemic agents but the available range of these agents and their effectiveness in managing pain in chronic wounds is not so well understood. This review will focus on such agents across a range of the most common chronic wounds.

The Diagnostic Accuracy and Clinimetric Properties of Screening Instruments to Identify Frail Older Adults Attending Emergency Departments: A Protocol for a Mixed Methods Systematic Review and Meta-Analysis.

BACKGROUND: Prompt and efficient identification and stratification of patients who are frail is important, as this cohort are at high risk of adverse healthcare outcomes. Numerous frailty screening tools have been developed to support their identification across different settings, yet relatively few have emerged for use in emergency departments (EDs). This protocol provides details for a systematic review aiming to synthesize the accumulated evidence regarding the diagnostic accuracy and clinimetric properties of frailty screening instruments to identify frail older adults in EDs. METHODS: Six electronic databases will be searched from January 2000 to March 2021. Eligible studies will include adults aged ≥60 years screened in EDs with any available screening instrument to identify frailty (even if not originally designed for this purpose). Studies, including case-control, longitudinal, and cohort studies, will be included, where instruments are compared to a reference standard to explore diagnostic accuracy. Predictive accuracy for a selection of outcomes, including mortality, institutionalization, and readmission, will be assessed. Clinical and methodological heterogeneity will be examined, and a random effects meta-analysis performed if appropriate. CONCLUSION: Understanding whether frailty screening on presentation to EDs is accurate in identifying frailty, and predicting these outcomes is important for decision-making and targeting appropriate management.

Enrichment of dementia caregiving relationships through psychosocial interventions: A scoping review.

Objectives: Enrichment, defined as "the process of endowing caregiving with meaning or pleasure for both the caregiver and care recipient" can support relationships between people living with dementia (PLWD) and their caregivers. This study aims to explore (1) the types of psychosocial interventions that may enrich relationships between dementia caregiving dyads, and (2) the components within these psychosocial interventions that may contribute to enrichment. Methods: A scoping review was conducted based on the Joanna Briggs Institute framework. We operationalized and contextualized core elements from Cartwright and colleagues' enrichment model, which was also used to guide the review. Five electronic databases were searched. Psychosocial intervention components contributing to enrichment were identified and grouped within each core element. Results: Thirty-four studies were included. Psychosocial interventions generating enrichment among dyads mainly involved supporting dyadic engagement in shared activities, carer education or training, or structural change to the environment around PLWD. Intervention components contributing to the enrichment of dyadic relationships were identified within "acquired symbolic meaning", "performing activity", and "fine tuning". Dyadic communication support and skill-building were common contributors to enrichment. Conclusion: Our findings may inform the planning and development of interventions to enrich dyadic relationships in the context of dementia. In formal caregiving contexts, future interventions may consider dedicating space for relationships to build and grow through positive interactions. In informal caregiving contexts, existing relationships should be considered to better support dyads engage in positive interactions.

Experiences and perceptions of Turkish intensive care nurses providing care to Covid-19 patients: A qualitative study.

AIM: To describe the experiences of intensive care nurses who provided care to Covid-19 patients and their perceptions towards the disease and their work conditions during the pandemic. INTRODUCTION: Identification of experiences and perceptions of intensive care nurses towards disease, care and their workplace conditions when providing care to Covid-19 patients will inform decision-makers about improvements that can be implemented. BACKGROUND: The Covid-19 pandemic has led to increased strain and workplace-related health risks to intensive care nurses, but it has also provided a unique experience and opportunities for learning and development. METHODS: A descriptive qualitative study was conducted with 10 intensive care unit nurses working in seven hospitals in Istanbul, Turkey. Snowball sampling method was used, and the data were collected by semistructured online interviews. A thematic analysis was performed. The Consolidated Criteria for Reporting Qualitative Research were followed. FINDINGS: Five major themes were identified: 'death and fear of death', 'impact on family and social lives', 'nursing care of Covid-19 patients', 'changing perceptions of their own profession: empowerment and dissatisfaction', and 'experiences and perceptions of personal protective equipment and other control measures'. DISCUSSION: Intensive care nurses experience an increased risk of infection and psychological burden, and they lack a sense of professional satisfaction. Improvements to working conditions are needed to support nurses caring for patients during the pandemic. CONCLUSION: The pandemic increased the workload and responsibilities of intensive care nurses and led to increases in their work-related health risks and challenges with care. However, it also increased nurses' awareness about the importance of their professional roles. IMPLICATIONS FOR NURSING PRACTICE AND POLICIES: There is a need to improve working conditions and develop nursing standards for the care of Covid-19 patients in intensive care units.

Early identification of frailty: Developing an international delphi consensus on pre-frailty.

BACKGROUND: Frailty is associated with a prodromal stage called pre-frailty, a potentially reversible and highly prevalent intermediate state before frailty becomes established. Despite being widely-used in the literature and increasingly in clinical practice, it is poorly understood. OBJECTIVE: To establish consensus on the construct and approaches to diagnose and manage pre-frailty. METHODS: We conducted a modified (electronic, two-round) Delphi consensus study. The questionnaire included statements concerning the concept, aspects and causes, types, mechanism, assessment, consequences, prevention and management of pre-frailty. Qualitative and quantitative analysis methods were employed. An agreement level of 70% was applied. RESULTS: Twenty-three experts with different backgrounds from 12 countries participated. In total, 70 statements were circulated in Round 1. Of these, 52.8% were accepted. Following comments, 51 statements were re-circulated in Round 2 and 92.1% were accepted. It was agreed that physical and non-physical factors including psychological and social capacity are involved in the development of pre-frailty, potentially adversely affecting health and health-related quality of life. Experts considered pre-frailty to be an age-associated multi-factorial, multi-dimensional, and non-linear process that does not inevitably lead to frailty. It can be reversed or attenuated by targeted interventions. Brief, feasible, and validated tools and multidimensional assessment are recommended to identify pre-frailty. CONCLUSIONS: Consensus suggests that pre-frailty lies along the frailty continuum. It is a multidimensional risk-state associated with one or more of physical impairment, cognitive decline, nutritional deficiencies and socioeconomic disadvantages, predisposing to the development of frailty. More research is needed to agree an operational definition and optimal management strategies.

Effectiveness of reminiscence therapy in reducing agitation and depression and improving quality of life and cognition in long-term care residents with dementia: A systematic review and meta-analysis.

This paper assesses the effectiveness of reminiscence therapy (RT) in people with mild to moderate dementia in long-term care facilities. A literature search was conducted in CINAHL, MEDLINE, PsychINFO, and Embase from inception to December 2020. Five RCTs with 267 participants were included; two were meta-analysed. Cochrane collaboration's risk of bias tool was used to evaluate the methodological quality of the included RCTs, and the risk of bias across studies was assessed using the GRADE method. The overall quality of evidence was moderate to low. Among the five trials, none measured the efficacy of RT on agitation. Reminiscence therapy was effective in reducing depression and improving autobiographical memory, but its effects were inconsistent. There was a significant improvement in quality of life (QoL) following RT. The meta-analysis showed no statistical significance on the pre-post intervention differences in depression (SMD -0.28, 95%CI -0.91-0.35, p > 0.05) and autobiographical memory scores (SMD 0.57, 95%CI -0.07-1.21, p > 0.05). Reminiscence therapy may have some benefits in reducing depression and improving the QoL and cognition in this population; however, its effectiveness should be tested further.

The relationship between frailty and diabetes: An investigation of self-rated health, depression symptoms and quality of life in the Study of Health Aging and Retirement in Europe.

AIMS: To assess the impact of diabetes and frailty on self-rated health, depressive symptoms and quality of life (QoL). METHODS: Data were pooled for participants aged ≥50 years from five waves of the Survey of Health, Ageing and Retirement in Europe. Measures included diabetes (self-reported), physical frailty (≥3/5 criteria), low self-rated health (SRH; "poor" or "fair"), depression (screened using the EURO-D ≥4) and low QoL (CASP-12 <35). Logistic regression was used to adjust for confounding. RESULTS: Participants with diabetes (n=11,661/97,691) were more likely to be older (68 vs. 64 years, p<0.001), male (50% vs. 45%, p<0.001) and frail (21% vs. 8%, p<0.001). Age, sex, diabetes and frailty were all independently associated with low SRH, depression and low QoL. Frailty had the highest adjusted odds ratios for low SRH (9.43; 95% CI:8.89-10.02), depression (6.39; 95% CI:6.07-6.71) and low QoL (9.65; 95% CI:9.17-10.16). For diabetes, the adjusted odds ratios were 2.82 (2.70-2.95), 1.49 (1.42-1.56) and 1.67 (1.60-1.74), respectively. Participants with both diabetes and frailty reported the worst self-rated health, the most depression symptoms and the lowest QoL. CONCLUSIONS: Frailty was prevalent in older people with diabetes and independently associated with low self-rated health, depressive symptoms and low QoL. Prompt identification and management of frailty should be a key consideration in diabetes care.

What is the "normal" wound bed temperature? A scoping review and new hypothesis.

Wound bed temperature measurement holds the potential to be a safe, easy to use, and low-cost tool to aid objective wound bed assessment, clinical decision making and improved patient outcomes. However, there is no consensus on the normal range of wound bed temperature in chronic wounds. We conducted a scoping review including any study type, from 2010 to 2020 in which chronic wound bed temperature was reported. Thirteen studies including 477 patients met our criteria. Venous ulcers (VLU) accounted for 46.5% (n = 222) of wounds; diabetic foot ulcers (DFU) for 25.4% (n = 121) with pressure ulcers (PU), mixed arterial venous ulcers (MAVLU) and unknown aetiology accounting for the remainder. The weighted mean of means for wound bed temperature was 31.7°C (n = 395) for all wound types; 31.7°C for VLU; 31.6°C for DFU; 33.3°C for PU; 30.9°C for MAVLU; and 32.0°C for those with unknown aetiology. Based on our review, we hypothesise that normal wound bed temperature is within a range of 30.2-33.0°C.

Prevalence of frailty in 62 countries across the world: a systematic review and meta-analysis of population-level studies.

INTRODUCTION: The prevalence of frailty at population level is unclear. We examined this in population-based studies, investigating sources of heterogeneity. METHODS: PubMed, Embase, CINAHL and Cochrane Library databases were searched for observational population-level studies published between 1 January 1998 and 1 April 2020, including individuals aged ≥50 years, identified using any frailty measure. Prevalence estimates were extracted independently, assessed for bias and analysed using a random-effects model. RESULTS: In total, 240 studies reporting 265 prevalence proportions from 62 countries and territories, representing 1,755,497 participants, were included. Pooled prevalence in studies using physical frailty measures was 12% (95% CI = 11-13%; n = 178), compared with 24% (95% CI = 22-26%; n = 71) for the deficit accumulation model (those using a frailty index, FI). For pre-frailty, this was 46% (95% CI = 45-48%; n = 147) and 49% (95% CI = 46-52%; n = 29), respectively. For physical frailty, the prevalence was higher among females, 15% (95% CI = 14-17%; n = 142), than males, 11% (95% CI = 10-12%; n = 144). For studies using a FI, the prevalence was also higher in females, 29% (95% CI = 24-35%; n = 34) versus 20% (95% CI = 16-24%; n = 34), for males. These values were similar for pre-frailty. Prevalence increased according to the minimum age at study inclusion. Analysing only data from nationally representative studies gave a frailty prevalence of 7% (95% CI = 5-9%; n = 46) for physical frailty and 24% (95% CI = 22-26%; n = 44) for FIs. CONCLUSIONS: Population-level frailty prevalence varied by classification and sex. Data were heterogenous and limited, particularly from nationally representative studies making the interpretation of differences by geographic region challenging. Common methodological approaches to gathering data are required to improve the accuracy of population-level prevalence estimates. PROTOCOL REGISTRATION: PROSPERO-CRD42018105431.